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Abstract Details
Impact of Hepatitis C cure on risk of mortality and morbidity in people with HIV after ART initiation
2023 May 10. doi: 10.1097/QAD.0000000000003594. Online ahead of print.
3Population Health Sciences, University of Bristol, Bristol, UK.
4Hospital Virgen de La Salud, Toledo, Spain.
5HIV Unit, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
6Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland.
7Department of Medicine, University of Washington, Seattle, WA, USA.
8Department of Medicine University of Calgary, Alberta, Canada.
9Department of Medicine & Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
10University Hospital Bonn, Department of Medicine I; Bonn, Germany.
11Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA.
12Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National & Kapodistrian University of Athens.
13CHU de Bordeaux, Service des Maladies Infectieuses et Tropicales, INSERM, U1219, Pl. Amélie Raba Léon, U121933000, Bordeaux, France.
14HIV Unit, Hospital Clinic, IDIBAPS, Barcelona University, Spain.
15Department of Dermatology and Venereology, Medical University of Innsbruck, 6020 Innsbruck, Austria.
16Austrian HIV Cohort Study, 6020 Innsbruck, Austria.
17Stichting HIV Monitoring, Amsterdam, the Netherlands.
18CHU de Bordeaux, Service d'information médicale, INSERM, Institut Bergonié, CIC-EC 1401, F-33000 Bordeaux, France.
Abstract
Objective: Hepatitis C Virus (HCV) co-infection is associated with increased morbidity and mortality in people with HIV (PWH). Sustained virological response (SVR) decreases the risk of HCV-associated morbidity. We compared mortality, risk of AIDS-defining events, and non-AIDS non-liver (NANL) cancers between HCV co-infected PWH who reached SVR and mono-infected PWH.
Design: Adult PWH from 21 cohorts in Europe and North America that collected HCV treatment data were eligible if they were HCV-free at time of ART initiation.
Methods: Up to 10 mono-infected PWH were matched (on age, sex, date of ART start, HIV acquisition route, and being followed at the time of SVR) to each HCV co-infected PWH who reached SVR. Cox models were used to estimate relative hazards (HR) of all-cause mortality, AIDS-defining events, and NANL cancers after adjustment.
Results: Among 62,495 PWH, 2,756 acquired HCV, of whom 649 reached SVR. For 582 of these, ≥1 mono-infected PWH could be matched, producing a total of 5,062 mono-infected PWH. The estimated HRs comparing HCV co-infected PWH who reached SVR with mono-infected PWH were 0.29 [95%CI 0.12-0.73] for mortality, 0.85 [0.42-1.74] for AIDS-defining events, and 1.21 [0.86-1.72] for NANL cancer.
Conclusion: PWH who reached SVR a short time after HCV acquisition were not at higher risk of overall mortality compared to mono-infected PWH. However, the apparent higher risk of NANL cancers in HCV co-infected PWH who reached SVR after a DAA-based treatment compared to mono-infected PWH, though compatible with a null association, suggests a need for monitoring of those events following SVR.